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Summary of Acupuncture Studies related to Reproductive Medicine

Compiled from Journals, Internet, and Website resources as a

tool to aid ABORM members understand the depth and breadth

of Western Style research related to our fields.

Worked completed by: Diane K. Cridennda, L.Ac., FABORM ,

Member Board of Directors

Founder/Owner: East Winds Acupuncture, web:

www.EastWindsAcupuncture.com

Also Phone: 719-520-5056

FOR SUGGESTIONS AND FURTHER ADDITIONS… EMAIL ME AT

INFO@EASTWINDSACUPUNCTURE.COM

http://www.eastwindsacupuncture.com/

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Table of Contents

Meta-Analysis

Miscellaneous

Acupuncture Embryo Transfer and other

publications

Acupuncture IVF Miscellaneous

Acupuncture & PCOS

Chinese Medicine herbs PCOS

Acupuncture Sperm

Acupuncture and wellbeing of IVF patients

Acupuncture and pregnancy

Acupuncture and herbal formulas infertility IVF

Abstracts

Research into Chinese Medicine and ovarian

dysfunction

Research into Recurrent Miscarriage & Chinese

herbal Medicine

Infertility and Chinese Herbal formulas

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Meta-Analysis

Acupuncture and herbal medicine in in vitro fertilization: a review of

the evidence for clinical practice

Cheong Y et al, Hum Fert 2010, Vol. 13, No. 1, Pg 3-12.

Human Fertility

A further analysis by the authors of the previously published Cochrane databases included more

trials in their analysis of the benefit of acupuncture at embryo transfer. They included a trial

which had previously been excluded due to the fact that its methodology introduced too much

heterogeneity - this plus the inclusion of another trial which controversially used placebo

acupuncture reduced the measurable benefits of acupuncture to IVF patients in this analysis.

Abstract

The objectives of this systematic review were to determine the effectiveness of (a) acupuncture

and (b) Chinese herbal medicine on the treatment of male and female subfertility by assisted

reproductive technologies (ART). All reports from RCTs of acupuncture and/or Chinese herbal

medicine in ART were obtained via searches through The Cochrane Menstrual Disorders and

Sub-fertility Group's Specialized Register of controlled trials, and other major databases. The

outcome measures were determined prior to starting the search, and comprised: live birth rate,

ongoing pregnancy rate, clinical pregnancy rate, the incidence of ovarian hyperstimulation

syndrome and multiple pregnancy, miscarriage rate and adverse effects arising from treatment.

Overall, 14 trials (a total of 2670 subjects) were included in the meta-analysis. The results

provided no evidence of benefit in the use of acupuncture during assisted conception. Further

studies should attempt to explore the potential placebo, as well as treatment, effects of this

complimentary therapy. Essential elements for a quality RCT will be the size of the trial, the use

of a standardized acupuncture method and of placebo needles.

Acupuncture and assisted conception

Cheong Y et al, Cochrane Database of Systematic Reviews 2009 Issue 1

Cochrane Database

A newer version of this data base by the same authors as the one listed above concluded that

there is an increase in live birth rate when acupuncture is performed on day of embryo transfer.

Abstract

Background

Acupuncture has recently been studied in assisted reproductive treatment (ART) although its

role in reproductive medicine is still debated.

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Objectives

To determine the effectiveness of acupuncture in the outcomes of ART.

Search strategy

All reports which describe randomized controlled trials of acupuncture in assisted conception

were obtained through searches of the Menstrual Disorders and Subfertility Group Specialized

Register, CENTRAL, Ovid MEDLINE (1996 to August 2007), EMBASE (1980 to August 2007),

CINAHL (Cumulative Index to Nursing & Allied Health Literature) (1982 to August 2007), AMED,

National Research Register, Clinical Trials register (www.clinicaltrials.gov), and the Chinese

database of clinical trials.

Selection criteria

Randomized controlled trials of acupuncture for couples who were undergoing ART comparing

acupuncture treatment alone or acupuncture with concurrent ART versus no treatment, placebo

or sham acupuncture plus ART for the treatment of primary and secondary infertility. Women

with medical illness deemed contraindications for ART or acupuncture were excluded.

Data collection and analysis

Sixteen randomized controlled trials were identified that involved acupuncture and assisted

conception. Thirteen trials were included in the review and three were excluded. Quality

assessment and data extraction were performed independently by two review authors. Meta-

analysis was performed using odds ratio (OR) for dichotomous outcomes. The outcome

measures were live birth rate, clinical ongoing pregnancy rate, miscarriage rate, and any

reported side effects of treatment.

Main results

There is evidence of benefit when acupuncture is performed on the day of embryo transfer (ET)

on the live birth rate (OR 1.86, 95% CI 1.29 to 2.77) but not when it is performed two to three

days after ET (OR 1.79, 95% CI 0.93 to 3.44). There is no evidence of benefit on pregnancy

outcomes when acupuncture is performed around the time of oocyte retrieval.

Authors' conclusions

Acupuncture performed on the day of ET shows a beneficial effect on the live birth rate;

however, with the present evidence this could be attributed to placebo effect and the small

number of women included in the trials. Acupuncture should not be offered during the luteal

phase in routine clinical practice until further evidence is available from sufficiently powered

RCTs.

The data from this meta-analysis suggests that acupuncture does increase the live birth rate

with in vitro fertilization (IVF) treatment when performed around the time of embryo transfer.

However, this could be attributed to placebo effect and the small number of trials included in the

review. Larger studies are necessary to confirm the results. Acupuncture may have potential

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harmful effects in early pregnancy and hence clinicians should be cautious when giving advice

regarding the use of acupuncture in early pregnancy.

Effects of acupuncture on rates of pregnancy and live birth among

women undergoing in vitro fertilization: systematic review and meta-

analysis.

Manheimer E et al. BMJ 2008;336 pg 545-549

British Medical Journal

Early in 2008, the prestigious British Medical journal published its own analysis of the

acupuncture in a meta-analysis of 7 of these trials; i.e. they chose only those which met strict

research criteria.

The authors concluded,

―The odds ratio of 1.65 suggests that acupuncture increased the odds of clinical pregnancy by

65% compared with the control groups… In absolute terms 10 patients would need to be treated

with acupuncture to bring about one additional clinical pregnancy. These are clinically relevant

benefits.‖

And when they analyzed the 4 trials that measured live births in addition to pregnancy rates,

they found that acupuncture increased the odds by 91% and that the number of patients who

would need to be treated to bring about an additional pregnancy dropped to 9.

Impressive as these results are they may still be an underestimate, since the authors included

women whose IVF cycles were cancelled before transfer.

The accompanying editorial in the BMJ makes the comment that adding acupuncture to IVF

improved pregnancy rates more than any other recent improvement or advance in IVF

technology.

Abstract

Objective - To evaluate whether acupuncture improves rates of pregnancy and live birth when

used as an adjuvant treatment to embryo transfer in women undergoing in vitro fertilization.

Design - Systematic review and meta-analysis.

Data sources - Medline, Cochrane Central, Embase, Chinese Biomedical Database, hand

searched abstracts, and reference lists.

Review methods - Eligible studies were randomized controlled trials that compared needle

acupuncture administered within one day of embryo transfer with sham acupuncture or no

adjuvant treatment, with reported outcomes of at least one of clinical pregnancy, ongoing

pregnancy, or live birth. Two reviewers independently agreed on eligibility; assessed

methodological quality; and extracted outcome data. For all trials, investigators contributed

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additional data not included in the original publication (such as live births). Meta-analyses

included all randomized patients.

Data synthesis - Seven trials with 1366 women undergoing in vitro fertilization were included in

the meta-analyses. There was little clinical heterogeneity. Trials with sham acupuncture and no

adjuvant treatment as controls were pooled for the primary analysis. Complementing the

embryo transfer process with acupuncture was associated with significant and clinically relevant

improvements in clinical pregnancy (odds ratio 1.65, 95% confidence interval 1.27 to 2.14;

number needed to treat (NNT) 10 (7 to 17); seven trials), ongoing pregnancy (1.87, 1.40 to 2.49;

NNT 9 (6 to 15); five trials), and live birth (1.91, 1.39 to 2.64; NNT 9 (6 to 17); four trials).

Because we were unable to obtain outcome data on live births for three of the included trials,

the pooled odds ratio for clinical pregnancy more accurately represents the true combined effect

from these trials rather than the odds ratio for live birth.

The results were robust to sensitivity analyses on study validity variables. A prespecified

subgroup analysis restricted to the three trials with the higher rates of clinical pregnancy in the

control group, however, suggested a smaller non-significant benefit of acupuncture (odds ratio

1.24, 0.86 to 1.77).

Conclusions - Current preliminary evidence suggests that acupuncture given with embryo

transfer improves rates of pregnancy and live birth among women undergoing in vitro

fertilization.

A Systematic Review and Meta -analysis of the effect of Acupuncture

on Outcome of in Vitro Fertilization Treatment

El-Toukhy T et al BJOG 2008 115 (10); 1203 -13

British Journal of Obstetrics and Gynecology

Another meta-analysis also reported at an annual fertility conference indicated that in the trials

they chose to include they found no effect of acupuncture on IVF treatment. This meta-analysis

included a trial which had been excluded from the previous analysis because it employed

different methodology and therefore introduced a degree of heterogeneity which reduces the

validity of this meta-analysis.

Abstract

BACKGROUND: Numerous randomized studies have reported pregnancy outcome in women

who received acupuncture during their in vitro fertilization (IVF) treatment cycle. OBJECTIVE:

The objective of this study was to conduct a systematic review with meta-analysis of the trials of

acupuncture during IVF treatment on the outcomes of clinical pregnancy and live birth rates.

SEARCH STRATEGY: Searches were conducted in MEDLINE, EMBASE, Cochrane Library, ISI

Proceedings and SCISEARCH. SELECTION CRITERIA: All randomized controlled trials that

evaluated the effects of acupuncture compared with no treatment or sham acupuncture in

women undergoing IVF-intracytoplasmic sperm injection treatment were included. DATA

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COLLECTION AND ANALYSIS: Study selection, quality appraisal and data extraction were

performed independently and in duplicate. A sensitivity analysis was conducted where the meta-

analysis was restricted to trials in which sham acupuncture was used in the control group. Meta-

regression analysis was used to explore the association between study characteristics and

pregnancy rates. MAIN RESULTS: Thirteen relevant trials, including a total of 2500 women

randomized to either acupuncture or control group, were identified. No evidence of publication

bias was found (Begg's test, P = 0.50). Five trials (n = 877) evaluated IVF outcome when

acupuncture was performed around the time of transvaginal oocyte retrieval, while eight trials (n

= 1623) reported IVF outcome when acupuncture was performed around the time of embryo

transfer (ET). Meta-analysis of the five studies of acupuncture around the time of egg collection

did not show a significant difference in clinical pregnancy (relative risks [RR] = 1.06, 95% CI

0.82-1.37, P = 0.65). Meta-analysis of the eight studies of acupuncture around the time of ET

showed no difference in the clinical pregnancy rate (RR = 1.23, 95% CI 0.96-1.58, P = 0.1). Live

birth data were available from five of the eight studies of acupuncture around the time of ET.

Meta-analysis of these studies did not show a significant increase in live birth rate with

acupuncture (RR = 1.34, 95% CI 0.85-2.11). Using meta-regression, no significant association

between any of the studied covariates and clinical pregnancy rate was found (P > 0.05 for all

covariates). CONCLUSION: Currently available literature does not provide sufficient evidence

that adjuvant acupuncture improves IVF clinical pregnancy rate.

Traditional Chinese medicine and infertility.

Huang, S T and Chen, A P C, Current Opinion in Obstetrics & Gynecology. 2008, 2(3):211-215.

Current Opinion in Obstetrics & Gynecology

A recent review of current medical literature carried out by researchers in Taiwan noted that

―traditional Chinese medicine could regulate the gonadotropin-releasing hormone to induce

ovulation and improve the uterus blood flow and menstrual changes of endometrium. In

addition, it also has impacts on patients with infertility resulting from polycystic ovarian

syndrome, anxiety, stress and immunological disorders.‖ Their review concludes ―Integrating the

principles and knowledge from well characterized approaches and quality control of both

traditional Chinese medicine and Western medical approaches should become a trend in

existing clinical practice and serve as a better methodology for treating infertility.‖

Abstract

Purpose of review: The present review gives an overview of the potential use of traditional

Chinese medicine in the treatment of infertility, including an evidence-based evaluation of its

efficacy and tolerance.

Recent findings: Recent studies demonstrated that traditional Chinese medicine could regulate

the gonadotropin-releasing hormone to induce ovulation and improve the uterus blood flow and

menstrual changes of endometrium.

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In addition, it also has impacts on patients with infertility resulting from polycystic ovarian

syndrome, anxiety, stress and immunological disorders.

Although study design with adequate sample size and appropriate control for the use of

traditional Chinese medicine is not sufficient, the effective studies have already indicated the

necessity to explore the possible mechanisms, that is, effective dose, side effect and toxicity of

traditional Chinese medicine, in the treatment of infertility by means of prospective randomized

control trial.

Summary: The growing popularity of traditional Chinese medicine used alone or in combination

with Western medicine highlights the need to examine the pros and cons of both Western and

traditional Chinese medicine approaches. Integrating the principle and knowledge from well

characterized approaches and quality control of both traditional Chinese medicine and Western

medical approaches should become a trend in existing clinical practice and serve as a better

methodology for treating infertility.

The Role of Acupuncture in the Management of Subfertility

Ng E H et al Fertil Steril. 2008 Jul;90(1):1-13.

Fertility and Sterility

Another review of the literature from a group in Hong Kong concludes that the positive effect of

acupuncture in the treatment of subfertility may be related to the central sympathetic inhibition

by the endorphin system, the change in uterine blood flow and motility, and stress reduction.

Abstract

OBJECTIVE: To review systematically the use of acupuncture in the management of subfertility.

DESIGN: A computer search was performed via several English and Chinese databases to

identify journals relevant to the subject.

RESULT(S): The positive effect of acupuncture in the treatment of subfertility may be related to

the central sympathetic inhibition by the endorphin system, the change in uterine blood flow and

motility, and stress reduction. Acupuncture may help restore ovulation in patients with polycystic

ovary syndrome, although there are not enough randomized studies to validate this.

There is also no sufficient evidence supporting the role of acupuncture in male subfertility, as

most of the studies are uncontrolled case reports or case series in which the sample sizes were

small. Despite these deficiencies, acupuncture can be considered as an effective alternative for

pain relief during oocyte retrieval in patients who cannot tolerate side effects of conscious

sedation.

The pregnancy rate of IVF treatment is significantly increased, especially when acupuncture is

administered on the day of embryo transfer.

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CONCLUSION(S): Although acupuncture has gained increasing popularity in the management

of subfertility, its effectiveness has remained controversial.

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Miscellaneous

Effect of acupuncture on the outcome of in vitro fertilization and

intracytoplasmic sperm injection: a randomized, prospective,

controlled clinical study

Dieterle S et al, Fertil Steril 2006 Vol 85, pg 1347-1351

Fertility and Sterility

Abstract

OBJECTIVE: To determine the effect of luteal-phase acupuncture on the outcome of IVF /

intracytoplasmic sperm injection (ICSI).

DESIGN: Randomized, prospective, controlled clinical study.

SETTING: University IVF center.

PATIENT(S): Two hundred twenty-five infertile patients undergoing IVF/ICSI.

INTERVENTION(S): In group I, 116 patients received luteal-phase acupuncture according to the

principles of traditional Chinese medicine. In group II, 109 patients received placebo

acupuncture.

MAIN OUTCOME MEASURE(S): Clinical and ongoing pregnancy rates.

RESULT(S): In group I, the clinical pregnancy rate and ongoing pregnancy rate (33.6% and

28.4%, respectively) were significantly higher than in group II (15.6% and 13.8%).

CONCLUSION(S): Luteal-phase acupuncture has a positive effect on the outcome of IVF/ICSI.

Acupuncture: Impact on Pregnancy Outcomes in IVF Patients

12th World Congress on Human Reproduction, Venice Italy March 2005

Paul C. Magarelli, M.D., Ph.D. Reproductive Medicine & Fertility Center, Colorado Springs

Diane Cridennda, L.Ac. East Winds Acupuncture Mel Cohen, MBA Reproductive Medicine &

Fertility Center, Colorado Springs

Abstract

Take Home babies' rates (THB) have been the sine quo non of IVF outcomes. Pregnancy rates

(PR) can overestimate the expected success of a high-technology treatment for patients and

many clinics use PR as means of marketing their practices. This has caused disillusionment in

patients and government regulation (especially in the U.S.). Each IVF program strives to

improve reproductive outcomes (low ectopic rates, low miscarriage rates and improved take

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home baby rates - live births). Usually the approach to these improvements are changes in IVF

protocols, media adjustments in the IVF lab, patient selection, and subtle nudges towards egg

donors for poor responders. Another approach has been the inclusion of alternative medical

modalities: acupuncture, massage therapy, stress reduction techniques, herbal medicine. We,

and others, have chosen to incorporate Acupuncture into our IVF treatment protocols. Recently

we presented two studies that demonstrated improvements in pregnancy rates in Good and

Poor IVF Responders with the inclusion of two specific Acupuncture Protocols (Steiner-Victorin

and Paulus et. Al). In the poor responders group we demonstrated a positive adjustment to Poor

Responders pregnancy rates (PR) with improvements in PR in the Poor Responders group

equivalent to good responders. In the Good Responders study we demonstrated a trend

towards improved PR (5% above controls, not significant at p < 0.05). With these observations

noted we have continued our investigation and are reporting on reproductive outcomes in all IVF

patients treated with Acupuncture compared to those untreated.

Materials and Methods: In this study 130 IVF cycles were reviewed in a retrospective fashion.

Patients demographics, years infertile, age of male partners, sperm parameters, Day 3 FSH,

Pulsitility Indices, Weight, BMI, infertility diagnoses, IVF treatment protocols were statistically

similar for both the Controls (C) and Acupuncture (Ac) treatment groups. All patients that

completed an IVF cycle (retrieval, transfer) were included. There were 82 in the C group (non

acupuncture) and 48 in the Ac group. For the C vs. Ac groups a summary of their statistics are

as follows: Mean Age was 32.6 vs. 32.7, Day 3 FSH was 5.5 vs. 6.4, Pulsitility Indices for right

and left uterine arteries were 1.5 and 1.2 vs. 1.4 and 1.0; Sperm counts were 69 vs. 67

million/ml; Sperm motility (%) were 48 vs. 53%, and Sperm morphologies were 6 % normal vs.

7%.

Results: Pregnancy rates for the Ac group were statistically similar, although numerically higher,

versus C (50% v 45% at P < 0.05). Ac miscarriage rates (SAB) were statistically lower than the

C (8 % vs. 11% at p

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Materials and Methods: In this retrospective study, data was extracted from medical records of

patients RE&I clinic & acupuncture clinics between January 2001 and November 2003. All

patients completing an IVF cycle with transfer were included. One RE&I provided the IVF care

and a consortium of acupuncturists overseen by the author provided the strict acupuncture

protocols. PR per transfer were the endpoints measured. Data was analyzed by student’s t test

and Multiregression with Wilcox ranking (MRW).

Results: 147 patients were included in the study and of those 53 had Acupuncture (Ac) and 94

did not (Non-Ac group). Demographic data between these Ac and Non-Ac groups respectively

indicated remarkable equity (Table 1). Fertility Factors also demonstrated equity and there were

no differences in Diagnoses, IVF Protocols and type of Gonadotropin protocols used.

Factors that demonstrated significance were: Length of time infertile, Peak FSH, PI for total

group without MRW; PI for MRW groups reversed this (Table 2) and finally average: Sperm

Morphology, Peak E2, Peak P4 prior to HCG: and endometrial thickness. PR before Wilcox

ranking were the same: 40% v 38%. MRW analysis revealed FSH, Length of time trying to get

pregnant, Sperm Morphology and E2 levels as significant: 6.5, 4.1, 4.0 and 1.6 respectively.

When the Ac group was modified (15 Ac patient dropped), PI was elevated from 1.76 to 1.94

resulting in a significant elevation compared to the Non-Ac group, p 0.01. Also PR changed from

40% before to 53% after and this value was significantly greater than the Non-Ac group (38%),

p 0.01.

Conclusions: Significant increases in pregnancy outcomes were confirmed by this study and the

data uniquely supported the advantage of acupuncture in patients with normal PI (prior studies

were done on patient with PI). We also demonstrated that both acupuncture treatment protocols

could be used together with a synergistic effect. Finally, this study is the first to demonstrate that

the use of acupuncture in patients with poor prognoses (elevated Peak FSH, longer history of

infertility, poor sperm morphology) can achieve similar pregnancy rates to normal prognosis

patients.

Acupuncture and Good Prognosis IVF Patients: Synergy

P. C. Magarelli, D. K. Cridennda, M. Cohen. Reproductive Medicine & Fertility Center, Colorado

Springs, CO; East Winds Acupuncture, Inc., Colorado Springs, CO.

FERTILITY AND STERILITY®, Proceedings from the 2004 ASRM meeting in Philadelphia

OBJECTIVE: To determine the role of electro stimulation acupuncture and traditional combined

with auricular acupuncture on IVF outcomes in good prognosis patients.

DESIGN: Retrospective case controlled clinical study. Acupuncture Consortium for treatment

standardization. Reproductive Endocrinology & Infertility IVF Private Practice and Traditional

Chinese Medicine Acupuncture Clinics.

MATERIALS AND METHODS: One hundred fourteen infertile patients undergoing controlled

ovarian hyperstimulation with gonadotropins and GnRH agonist and antagonist for IVF-ET

(2001 to 2003) in private practice IVF clinic. Only IVF patients with normal Day 3 FSH, normal

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uterine artery Pulsitility indices, sperm morphologies over 7% normal by Kruger Strict Criteria

and good response to ovarian hyperstimulation protocols (i.e., E2 over 2000 pg/ml) were

analyzed. Intervention (s): Electrostimulation acupuncture - reduction of Pulsitility Index (PI) of

the uterine artery and Traditional combined with Auricular acupuncture - Pre/Post embryo

transfer protocols were used alone or in combination and resultant pregnancy outcomes were

measured after IVF treatments. Main Outcome Measure(s): Cycles were grouped according to

those that received No Acupuncture (Non-Ac) and those that received either one or both

acupuncture treatments (Ac). Comparisons were made between Acupuncture treated IVF

patients and Non-Acupuncture treated IVF patients in clinical pregnancies, ongoing pregnancies

and birth outcomes. The statistics used for this analysis included; Tests for normal distribution:

chi-square test, Kolmogorov-Smirnov Test Unpaired T-tests Stepwise Multiple regression

Variance ratio test (F-Test) One-Way analysis of variance (ANOVA) with Student-Newman-

Keuls (SNK) test for pair wise comparison of subgroups.

RESULTS: Total IVF cases 114, 53 with Acupuncture (Ac) and 61 without Acupuncture (Non-

Ac). Demographics, Infertility Diagnoses, and Treatment Protocols were statistically the same

between both groups and by design, the following parameters were similar: Sperm Morphology;

Peak Day 3 FSH; Average Pulsitility Index; Peak E2 at hCG; and Post hCG P4. These

parameters earned the designation of Good Prognosis group. Pregnancy rates (PR) and

Miscarriage rates (SAB) were statistically improved at the p < 0.05 levels in those patients that

received Acupuncture (51% v 36% PR and 8% v 20% SAB in the AC v Non-Ac groups). There

were no ectopic pregnancies in the Ac group and 9% in the Non-Ac group, p < 0.008. Finally,

Birth rates (BR) per cycle start and per pregnancy were significantly higher in the Ac group, with

23% more births/pregnancy significant at the p < 0.05 level.

CONCLUSION: The use of adjunctive therapies in IVF protocols is gaining popularity. In

previously published data, Acupuncture was reserved for Poorer Prognosis patients and

enhanced outcomes were observed. In this study, we demonstrated that Good Prognosis

patients would also benefit from inclusion of published Acupuncture protocols. This is also the

first publication of Birth outcome data in Acupuncture treated IVF patients. Acupuncture

significantly increased birth outcomes; it significantly decreased ectopic pregnancies and

miscarriage rates. These data uniquely support a definitive role of both Electrostimulation and

Traditional combined with Auricular Acupuncture in IVF in Good Prognosis IVF patients.

Supported by: None.

Quintero R et al, Fertil Steril 2004 Vol 81 Suppl 3, pg S11-12

Fertility and Sterility

Abstract

Objective: The purpose of this study was to determine if there are benefits of standard

acupuncture compared to sham acupuncture as an adjunct to IVF.

Materials and Methods: A randomized, controlled, double-blind, cross over pilot trial was

performed using a needle-like device (sham acupuncture) as a control. Approval from GAMC's

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Investigational Review Board was acquired. Inclusion criteria were women aged 18 to 42 years

with a history of failed IVF cycle(s); the presence of both ovaries; and a normal uterine cavity.

Exclusion criteria was Kruger morphology =3.0 in the

uterine arteries were treated with EA in a prospective, non-randomized study. Before inclusion

in the study and throughout the entire study period, the women were down-regulated with a

gonadotrophin-releasing hormone analogue (GnRHa) in order to exclude any fluctuating

endogenous hormone effects on the PI. The baseline PI was measured when the serum

oestradiol was

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In anovulatory infertility cases the hyperactive sympathetic system can be depressed by electro

acupuncture and the function of the hypothalamus-pituitary-ovarian axis can be regulated by

electro acupuncture via central sympathetic system

Relationship between Blood Radioimmunoreactive Beta-Endorphin

and Hand Skin Temperature During The Electro-Acupuncture

Induction of Ovulation

By Chen Bo Ying M.D. Lecturer of Neurobiology Institute of Acupuncture Research, and Yu Jin,

MD., Prof of Gynecology Obstetrics and Gynecology Hospital Shanghai Medical University

Shanghai, People’s Republic of China

Abstract:

Thirteen cycles of anovulation menstruation in 11 cases were treated with Electro-Acupuncture

(EA) ovulation induction. In 6 of these cycles which showed ovulation, the hand skin

temperature (HST) of these patients was increased after EA treatment. In the other 7 cycles

ovulation was not induced. There were no regular changes in HST of 5 normal subjects. The

level of radioimmunoreactive beta-endorphin (rß-E) fluctuated, and returned to the

preacupunctural level in 30 min. after withdrawal of needles in normal subjects. After EA, the

level of blood rß-E in cycles with ovulation declined or maintained the range of normal subjects.

But the level of blood rß-E and increase of HST after EA (r=-0.677, P

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uterus to adjust the patient’s axis function and recover ovulation. Treated on an average of 30

times, the patients’ symptoms improved to varying degrees. The marked effective rate was

35.29%, the total effective rate being 82.35%. BBT, VS, CMS, and B ultrasonic picture all

improved to some degree. The results also showed that acupuncture may adjust FSH, LH, and

E2 in two directions and raise the progesterone level, bringing them to normal. The animal

experiments confirmed this result. Results showed that acupuncture may adjust endocrine

function of the generative and physiologic axis of women, thus stimulating ovulation. The results

of this research will provide some scientific basis for treating and further studying this disorder.

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Acupuncture and embryo transfer, other publication

Use of Acupuncture before and after embryo transfer

Dalton-Brewer N et al, Hum Fert 2010 Vol 12 No 4 212 - 255

Human Fertility (abstracts from UK Fertility Societies Conference 2009)

This report describes outcomes for all patients who attended the London Bridge Fertility,

Gynaecology and Genetics Centre in London over a 2 year period and who had acupuncture .

In the acupuncture group positive pregnancy rates/ET were 44.6% comparing favorably with the

non-acupuncture historic control group. When they analyzed outcomes in different age groups

they discovered that acupuncture intervention was particularly effective in woman in the 35 - 39

and the over 40 group.

Abstract

Use of Acupuncture before and after embryo transfer

Nick Dalton-Brewer, David Gillott, Nataly Atalla, Mohamed Menabawey, Pauline Wright, & Alan

Thornhill

The London Bridge Fertility, Gynaecology and Genetics Centre, London, UK

All IVF cases in which acupuncture was administered before and after embryo transfer at a

large private infertility centre were reviewed for a 2 year period. All patients were treated by the

same practitioner (NDB) using Traditional Chinese Acupuncture (TCA). Patients received

acupuncture to the protocol developed by Paulus, W.E., Zhang, M., Strehler, E., El-Danasouri,

I., & Sterzik, K. (2002). Influence of acupuncture on the pregnancy rate in patients who undergo

assisted reproduction therapy. Fertility & Sterility, 77, 721–724: Liver 3, Spleen 8, Stomach 29,

Pericardium 6, GV 20 were manually stimulated five times over a 40-min period, at Bridge,

approximately 10–20 minutes prior to embryo transfer. Embryo transfer was carried out under

ultrasound guidance as per routine at Bridge. Ten minutes following embryo transfer acupoints

Spleen 6, Stomach 36, Spleen 10, Large Intestine 4 were manually stimulated five times over a

40-min period before discharging the patient. Ear points 34, 55 and 58 were used in both

treatments and not stimulated.

A total of 71 patients underwent 74 cycles involving acupuncture before and after embryo

transfer.

Overall, positive pregnancy rates/ET were 44.6% comparing favorably with the non-acupuncture

historic control group.

When analyzed by maternal age at time of treatment, biochemical pregnancy results for

acupuncture treated women were as follows:

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Results for women aged 35–39 years and those over 40 years were markedly better than

controls suggesting that acupuncture intervention of this type may be more effective in older

women. No side effects or complications were experienced by women receiving acupuncture.

Acupuncture is a safe, adjunct therapy in IVF and in other randomized clinical trials has been

shown to significantly improve outcomes when used at the IVF centre before and after embryo

transfer. Our preliminary data are encouraging and suggest that a trial involving older women

may be effective.

The relationship between perceived stress, acupuncture, and

pregnancy rates among IVF patients: A pilot study

Balk J et al, Compl Therapies in Clinical Practice 2010,16,154–157

Complementary Therapies in Clinical Practice

These researchers at a university IVF clinic in Pittsburgh were interested to investigate the

relationship between acupuncture, stress and pregnancy rates. The patients who received

acupuncture on the day of embryo of transfer had a pregnancy rate of 55.6% compared with the

control group pregnancy rate of 35.5%.

Abstract

The aim of this paper was to determine the effect of acupuncture on perceived stress levels in

women on the day of embryo transfer (ET), and to determine if perceived stress levels at

embryo transfer correlated with pregnancy rates. The study was an observational, prospective,

cohort study based at the University IVF center.

Patient(s): 57 infertile patients undergoing IVF or IVF/ICSI.

Interventions(s): Patients were undergoing Embryo Transfer with or without acupuncture as part

of their standard clinical care.

Main outcome measure(s): Perceive Stress Scale scores, pregnancy rates.

Result(s): women who received this acupuncture regimen achieved pregnancy 64.7%, whereas

those without acupuncture achieved pregnancy 42.5%. When stratified by donor recipient

status, only non-donor recipients potentially had an improvement with acupuncture (35.5%

without acupuncture vs. 55.6% with acupuncture). Those who received this acupuncture

regimen had lower stress scores both pre-ET and post-ET compared to those who did not.

Those with decreased perceived stress scores compared to baseline had higher pregnancy

rates than those who did not demonstrate this decrease, regardless of acupuncture status.

Conclusions(s): The acupuncture regimen was associated with less stress both before and after

embryo transfer, and it possibly improved pregnancy rates. Lower perceived stress at the time

of embryo transfer may play a role in an improved pregnancy rate.

19

A Randomized double blind comparison of real and placebo

acupuncture in IVF treatment.

So EWS et al. Human Reproduction 2009; 24: 341-8.

A randomized controlled trial that compared real acupuncture with sham acupuncture before

and after embryo transfer in 370 patients undergoing IVF treatment. The sham treatment used

pressure at the same locations as used for real acupuncture, in effect a comparison of

acupuncture and acupressure, not a placebo. The clinical pregnancy rate was significantly

higher in the sham acupuncture group than the real acupuncture group (55.1 versus 43.8%,

respectively, p=0.038). No significant differences were found in rates of ongoing pregnancy and

live birth between the two groups. Reduction of endometrial and sub-endometrial vascularity,

serum cortisol concentrations and anxiety levels were observed in both groups. The researchers

concluded that placebo acupuncture was associated with a significantly higher overall

pregnancy rate than real acupuncture, but that placebo acupuncture may not be inert.

A randomized double blind comparison of real and placebo

acupuncture in IVF treatment.

So et al, Hum Reprod. 2009 Feb;24(2):341-8.

Human Reproduction

Researchers in Hong Kong found no significant difference between the effects of placebo and

regular acupuncture in clinical or ongoing pregnancy rates however on initial hCG testing the

placebo group had more positive tests.

Both placebo and regular acupuncture significantly increased blood flow to the uterus, reduced

stress hormones and anxiety levels. These findings lead the researchers to suggest that

placebo acupuncture is in fact not inert. Placebo acupuncture needles prick the skin at the

acupuncture point but do not penetrate the skin. Many Japanese acupuncturists (who routinely

use minimal stimulation of acupuncture points) would argue strongly that this is not an inert

placebo procedure but a therapeutic one.

Unfortunately there was no control group in this trial which received no acupuncture.

Abstract

BACKGROUND: Acupuncture has been used during IVF treatment as it may improve outcome,

however, there are concerns about the true efficacy of this approach. This randomized double

blind study aimed to compare real acupuncture with placebo acupuncture in patients undergoing

IVF treatment.

METHODS: On the day of embryo transfer (ET), 370 patients were randomly allocated to either

real or placebo acupuncture according to a computer-generated randomization list in sealed

opaque envelopes. They received 25 min of real or placebo acupuncture before and after ET.

The endometrial and subendometrial vascularity, serum cortisol concentration and the anxiety

20

level were evaluated before and after real and placebo acupuncture. RESULTS: The overall

pregnancy rate was significantly higher in the placebo acupuncture group than that in the real

acupuncture group (55.1 versus 43.8%, respectively, P 5 0.038; Common odds ratio 1.578 95%

confidence interval 1.047–2.378). No significant differences were found in rates of ongoing

pregnancy and live birth between the two groups. Reduction of endometrial and subendometrial

vascularity, serum cortisol concentration and the anxiety level were observed following both real

and placebo acupuncture, although there were no significant differences in the changes in all

these indices between the two groups.

CONCLUSIONS: Placebo acupuncture was associated with a significantly higher overall

pregnancy rate when compared with real acupuncture. Placebo acupuncture may not be inert.

The impact of acupuncture on in vitro fertilization outcome.

Domar A et al Fertil Steril 2009 Vol 91 Issue 3 pg 723-6

Fertility and Sterility

Abstract

This study showed no acupuncture effect and the researchers felt this was due to the fact that

they included many women who didn't have good quality embryos available for transfer. While

acupuncture may help a woman become pregnant after the transfer of a healthy embryo, the

researcher noted in an interview, it can't repair an embryo with chromosomal defects or other

abnormalities. She added, "Despite the results of my own study, I still recommend acupuncture

to women going through IVF"

Objective: To replicate previous research on the efficacy of acupuncture in increasing

pregnancy rates (PR) in patients undergoing IVF and to determine whether such an increase

was due to a placebo effect.

Design: Prospective, randomized, controlled, single blind trial. Setting: Private, academically

affiliated, infertility clinic.

Patient(s): One hundred fifty patients scheduled to undergo embryo transfer.

Intervention(s): Subjects were randomized to either the acupuncture or control group.

Acupuncture patients received the protocol, as first described by Paulus and his colleagues, for

25 minutes before and after embryo transfer. Control subjects lay quietly. All subjects then

completed questionnaires on anxiety and optimism. The IVF staff remained blind to subject

assignment.

Main Outcome Measure(s): Clinical PRs, anxiety, optimism.

Result(s): Before randomization both groups had similar demographic characteristics including

age and psychological variables. There were no significant differences in PRs between the two

groups. Acupuncture patients reported significantly less anxiety post-transfer and reported

21

feeling more optimistic about their cycle and enjoyed their sessions more than the control

subjects.

Conclusion(s): The use of acupuncture in patients undergoing IVF was not associated with an

increase in PRs but they were more relaxed and more optimistic

Acupuncture performed before and after embryo transfer improves

pregnancy rates.

Youran D et al Fertil Steril 2008 Vol. 90, Suppl 1, pg S240

Fertility and Sterility

Abstract

OBJECTIVE: Conflicting evidence exists on whether acupuncture is beneficial for patients

undergoing In Vitro Fertilization (IVF) cycles. Therefore, this study was undertaken to determine

whether on-site acupuncture, per- formed both before and after embryo transfer, affects clinical

outcomes.

DESIGN: Retrospective data analysis.

MATERIALS AND METHODS: The Acupuncture Group consisted of 49 patients who received

acupuncture on-site before and after embryo transfer in 2007. The treatment did not follow the

Paulus protocol. The Control Group were 212 patients with no acupuncture undergoing IVF

cycles in the same time period. The data was subdivided by SART age classifications to

determine if acupuncture differentially benefitted certain age groups. Clinical Pregnancy Rate

(CPR) was defined as the presence of fetal cardiac activity. Loss Rate was the percentage of

pregnancies that did not proceed from a positive hCG to a clinical pregnancy. Data were

analyzed using the unpaired t-test and Fisher’s exact test, with significance defined as P <

0.05.

RESULTS: Patients with a positive hCG were significantly higher in the Acupuncture Group for

women less than 35 years old (63.3% vs.43.2%, p 1⁄4 0.048). The Acupuncture Group also had

a higher CPR in the under 35 category (60.0% vs. 34.6%, p 1⁄4 0.01). There were no

differences in the other age groups. Combining all the age groups, the cycle parameters

between the two Groups were equivalent, while the CPR was higher and the Loss Rate lower

for the Acupuncture group (Table 1).

TABLE 1. Cycle Data for All Age Groups

Acupuncture No Acupuncture P Value

N 49 212

Age 32.6 +4.2 32.0 + 3.8 0.33

No. Oocytes 13.7 + 6.6 13.2 +6.9 0.65

22

Cell Number 6.8 + 2.0 7.0 + 2.1 0.36

Fragmentation Score 2.5 + 0.6 2.5 + 0.6 1.00

No. Embryos Frozen 2.5 + 3.2 2.7 + 3.5 0.85

No. Embryos Transferred 2.3 + 0.6 2.2 + 0.6 0.29

Positive hCG (%) 57.1 (28/49) 45.8 (97/212) 0.16

Clinical Pregnancy (%) 55.1 (27/49) 34.4 (75/212) 0.01

Loss Rate (%) 3.6 (1/28) 22.7 (22/97) 0.02

CONCLUSIONS: Although other studies regarding acupuncture have been inconclusive,

perhaps these positive results are related to two important factors. The treatments were

performed on-site, eliminating the stress of traveling to another site before and after the embryo

transfer. Also, the acupuncture treatment protocol did not follow the traditional Paulus protocol,

thereby suggesting there is still more research to be done on how best to treat infertility issues

with acupuncture

Laser acupuncture before and after embryo transfer improves ART

delivery rates.

Fratterelli JL et al Fertil Steril 2008 Vol 90, Suppl 1,pg S105

Fertility and Sterility

Abstract

This study reports an increase in implantation rates with the use of laser acupuncture however

the overall pregnancy rates for laser or needle acupuncture were not significantly different to

control groups. The control groups in this trial had a high clinical pregnancy rate i.e. over 50%.

DESIGN: Prospect randomized double blind and placebo controlled.

MATERIALS AND METHODS: On the day of transfer, participants were randomly assigned to a

study group; needle acupuncture (AC), laser acupuncture (LZ AC), sham laser acupuncture (LZ

sham), relaxation (RX), or no treatment (NT). The AC and LZ AC puncture groups were

considered treatment groups, the RX controls for the additional rest before and after transfer,

and NT is the non-intervention group. Most significantly, the LZ Sham group provided an

important control group. The laser acupuncture device was randomly preprogrammed per case

to either fire (and provide LZ AC) or to not fire and thus provide a true double blind control group

(LZ sham). It was not possible for the patient or acupuncturist to know if the laser fired. No

contact occurs with the patient in laser acupuncture so there is no acupressure effect or contact

with the wrong meridians. All treatments were administered for 25 minutes before and after

embryo transfer. Outcomes were compared by Chi-square and multiple logistic regression

23

analysis to control for the potential confounders including female age, embryo quality, and day

of transfer (Table 1).

RESULTS: All treatments were well tolerated. No differences in terms of patient demographics,

cycle type, stimulation outcomes, embryo number and quality, day of embryo transfer,

transferring physician, or acupuncturist were found between the 5 study groups. Implantation

rates were significantly improved with laser acupuncture. Traditional needle acupuncture had

outcomes equivalent to the 3 control groups. Sub analyses of patient age and embryo transfer

day produced similar findings with laser acupuncture enhancing outcome rates.

CONCLUSIONS: This large prospective randomized and well controlled study consistently

demonstrated benefit to LZ AC. Treatment was well tolerated and significantly improved

implantation rates.

Table 1.

Clinical Outcomes (%) Rates

AC LZ AC LZ Sham RX NT P Values

Impl 28.9 33.7 26.8 24.9 30.2 < 0.05

Chem Preg 61.5 60.9 53.0 53.7 60.4 0.22

Clin Preg 51.5 54.5 43.9 45.3 50.3 0.19

Cont Preg 39.0 42.1 35.4 37.4 39.6 0.71

The effect of acupuncture on outcomes in in-vitro fertilization (IVF)

Udoff L. C. et al, Fertil Steril 2007 Vol 86, Issue 3, pg S145

Fertility and Sterility

Abstract

OBJECTIVE: To develop a protocol that could be used in future studies to evaluate whether

acupuncture improves pregnancy and delivery rates in patients undergoing IVF. DESIGN:

Randomized, sham treatment controlled pilot study.

MATERIALS AND METHODS: Patients planning to undergo IVF who meet inclusion/exclusion

criteria (age 40 years old at start of stimulation, highest basal FSH 10mIU/mL, 3 prior failed IVF

attempts, acupuncture naive) were randomly assigned to an acupuncture treatment group or a

sham treatment group.

Treatment sessions occurred before the start of gonadotropin stimulation, the day before the

oocyte retrieval, the day before the embryo transfer and the day after the embryo transfer.

24

Acupuncture was performed using manual manipulation at 6 to 10 points depending on the

timing of the acupuncture treatment. Sham treated patients had needles placed in non-meridian

points at a shallow depth. Patients were also given a questionnaire regarding their impressions

of acupuncture treatment and were asked to guess their group assignment.

Data was analyzed using chi-squared for dichotomous outcome variables (e.g. clinical

pregnancy rate, number of take home babies) and t-tests for continuous outcomes (e.g. age).

RESULTS: Twenty-two IVF cycles (19 patients) were randomized with thirteen patients

completing the study (14 cycles). Five cycles were not completed due to poor response to

ovarian stimulation (4 in the sham group, one in the real group). Other reasons for incomplete

cycles (all in the sham group) included a persistent ovarian cyst, no viable embryos for transfer

and personal reasons. The overall cycle cancellation rate was 32% compared to a 22% cycle

cancellation rate for non-study patients of a similar age treated at this center during a similar

time period (p.05).

In the 13 patients analyzed, the mean age was 35 years old (SD4.03). There was no statistical

difference between true and sham acupuncture groups with respect to age (Sham: Mean35,

SD4.6, Real: Mean34, SD4.6). Additionally, there was no significant difference between groups

in highest basal FSH, number of oocytes retrieved, or number of embryos transferred. There

was a significantly higher chemical pregnancy rate (80% versus 11.0%) in patients receiving

true acupuncture compared to sham acupuncture (p.05). The clinical pregnancy rates and the

take home baby rates showed a strong trend towards a higher rate with acupuncture treatment

though the difference was not statistically significant (60% real treatment vs. 11% sham

treatment, p.05.).

Regarding the questionnaire, only one patient correctly guessed their group assignment (real

acupuncture). All patients rated their experience as very positive or positive.

CONCLUSION: It is feasible to conduct a randomized, blinded, sham control trial to study the

impact of acupuncture on IVF success rates. Such a protocol is well accepted by patients.

Preliminary data shows a statistically significant improvement in the biochemical pregnancy rate

with acupuncture treatment. Additionally, acupuncture was associated with a strong trend

towards higher clinical pregnancy rates and take home baby rates, though more patients will

need to be studied to reach any final conclusions.

The effect of acupuncture in assisted reproduction techniques

Teshima D. R. K et al, Fertil Steril 2007 Vol 88, Suppl 1, pg S330

Fertility and Sterility

Abstract

OBJECTIVE: The aim of this study was to evaluate the effects of acupuncture on embryo

transfer by comparing the rates of clinical pregnancy.

25

DESIGN: Retrospective, interventional and longitudinal study.

MATERIALS AND METHODS: Study with a total of 111 cycles of patients who underwent

assisted reproduction techniques: in vitro fertilization (IVF) or intracytoplasmic sperm injection

(ICSI) from June/2005 to January/ 2007: 52 cycles with acupuncture and 59 cycles without

acupuncture. Acupuncture was performed, in specific points of the body including the ear,

immediately before and after the embryo transfer procedure and the needles were retained for

30 minutes per session. The embryo transfer was carried out under ultrasound guidance and

luteal phase support was given by trans-vaginal progesterone administration (Utrogestan) and

intramuscular progesterone. Outcome measure was clinical pregnancy rate.

RESULTS: The clinical pregnancy rate per cycle was observed in 27 of 52 (51.9%) patients in

the acupuncture group and 21 of 59 (35.6%) patients in the control group (P 1⁄40,083). The

mean age was 36.1 6.1 years in the control group and 36.4 years in the acupuncture group

(P1⁄40.785). The mean number of embryo transferred was 3.3 in the control group and 3.6 in

the acupuncture group (P1⁄40.462). The technique of embryo transfer was 5 cycles of IVF and

54 cycles of ICSI in the control group and 5 cycles IVF and 47 cycles of ICSI in the acupuncture

group (P 1⁄41.000). Both groups did not show statistics difference in the mean age, number of

embryo transferred and the technique procedure.

CONCLUSIONS: Although there was a higher pregnancy rate in the acupuncture group, this

difference was not statistically significant, probably because of the small number of patients in

both group. Acupuncture seems to be an important coadjutant in the treatment of infertility with

IVF or ICSI, and further research is needed to demonstrate its precisely effect.

Acupuncture in IVF Linked to Lower Miscarriage and Ectopic Rates

Cridennda Diane K, Magarelli Paul, Cohen Mel

Research Presented at ASRM 2007

PHILADELPHIA - Women who receive acupuncture during the stimulation phase of an in vitro

fertilization cycle and again immediately after embryo transfer have a higher live-birth rate than

do controls, according to the first acupuncture study with this end point.

"Other studies have looked at pregnancy rates, but what is really important is whether or not

there is a baby," said Paul C. Magarelli, M.D., who reported his findings at the annual meeting of

the American Society for Reproductive Medicine.

The retrospective study included 131 women who were undergoing standard in vitro fertilization

(IVF) or Intracytoplasmic sperm injection (ICSI). All of these women were considered good

prognosis candidates for IVF/ICSI and were given the choice of having acupuncture. A total of

83 women declined (controls) and 48 accepted. There were no significant differences between

the two groups in terms of infertility diagnoses, demographics, and treatment protocols, except

that sperm morphology was slightly better in the partners of women receiving acupuncture

(7.3% vs. 5.9 % normal forms with strict criteria evaluation), and the average uterine artery

Pulsitility index was lower in the acupuncture group (1.57 vs. 1.72), said Dr. Magarelli of the

26

department of ob.gyn. at the University of New Mexico, Albuquerque. The study found that

pregnancy rates per embryo transfer were not significantly different between the two groups

(50% in the acupuncture group and 45% in controls).The miscarriage rate was almost halved in

the acupuncture group (8% vs. 14%).In addition, the rate of ectopic pregnancies was

significantly lower in the acupuncture group-0 of 24 pregnancies (0%) vs. 2 of 37 pregnancies

(9%), said Dr. Magarelli, who is also in private practice in Colorado Springs and Albuquerque.

Thus, the live-birth rate per IVF/ICSI cycle was significantly higher in the acupuncture group

than in controls (21% vs. 16%).

"The live-birth rate per pregnancy is an even more telling number, since some cycles get

cancelled. There was a 42% live-birth rate per pregnancy in the acupuncture group, compared

to a 35% rate in the non-acupuncture group," Dr. Magarelli said in an interview with this

newspaper. ―We believe that what we are doing is improving the uterine environment such that

implantation is improved," he added. The study used two acupuncture protocols. The Stener-

Victorin electro stimulation protocol-which has been shown to reduce high uterine artery blood

flow impedance, or Pulsitility index (Hum. Reprod. 1996;11:1314-7)-was used for nine

treatments during ovarian stimulation. The second acupuncture technique-the Paulus protocol,

which has been associated with improved pregnancy rates (Fertil. Steril. 2002;77:721-4)-was

used within 24 hours before the embryo transfer and 1 hour after.

"This protocol has demonstrated reductions in uterine contractility, so by relaxing the uterus

before the embryo transfer and immediately after, we felt we were setting up a better

environment for implantation," Dr. Magarelli said.

RESULTS: The proportion of patients with a positive pregnancy test was higher in the control

group (36/46) than the acupuncture group (25/48) (78.3% vs. 52.1%, respectively; P%0.01).

More importantly, the clinical pregnancy rate was higher in the control group than in the

acupuncture group (69.6% vs. 43.8%, respectively; P%0.03). The groups were statistically

similar with respect to age, peak estradiol, number of oocytes retrieved, fertilization method,

fertilization rate, number of embryos transferred, and the proportion with blastocyst transfer.

CONCLUSIONS: In contrast to previous reports, acupuncture before and after embryo transfer

was associated with lower biochemical and clinical pregnancy rates when compared to the

control group. The value of acupuncture in patients undergoing IVF needs to be further

examined before recommending it to patients.

Acupuncture lowers pregnancy rates when performed before and

after embryo transfer

Craig L. B et al, Fertil Steril 2007 Vol 88, Suppl 1, pg S40

Fertility and Sterility

Abstract (not published)

27

OBJECTIVE: Acupuncture performed onsite before and after embryo transfer has been reported

to improve in vitro fertilization (IVF) outcome in patients with good quality embryos. The purpose

of this investigation was to evaluate whether acupuncture before and after embryo transfer

would alter pregnancy rates in patients undergoing IVF regardless of embryo quality if the

treatment was performed offsite.

DESIGN: Multi-center, prospective, randomized study.

MATERIALS AND METHODS: 107 patients undergoing IVF were randomized to acupuncture

vs. control group. The treatment group received acupuncture by one of two licensed

acupuncturists at an offsite location for 25 minutes before and after embryo transfer using a

modified Paulus protocol (protocol described by Paulus et. al. 2002 with the addition of Cv6

before and K3 after transfer). The control group underwent embryo transfer without any other

intervention. The IVF protocol was determined by the treating physician who was blinded to

assigned group. The main outcome measures were a positive quantitative hCG, clinical

pregnancy as manifested by fetal cardiac activity, and live birth (data pending). Chi-squared

analysis and Student’s t-test were used for statistical analyses. Of the 107 patients randomized,

94 completed the study (10 IVF cycles canceled, 3 patients withdrew).

Acupuncture and IVF embryo transfer, ART and PCOS

Acupuncture Med. 2006 Dec;24(4):157-63.

Use of acupuncture in female infertility and a summary of recent acupuncture studies related to

embryo transfer.

Stener-Victorin E, Humaidan P.

Institute of Neuroscience and Physiology, Sahlgrenska Academy, Goteborg University, Sweden.

elisabet.stener-victorin@neuro.gu.se

During the last five years the use of acupuncture in female infertility as an adjuvant to

conventional treatment in assisted reproductive technology (ART) has increased in popularity.

The present paper briefly discusses clinical and experimental data on the effect of acupuncture

on uterine and ovarian blood flow, as an analgesic method during ART, and on endocrine and

metabolic disturbances such as polycystic ovary syndrome (PCOS). Further it gives a summary

of recent studies evaluating the effect of acupuncture before and after embryo transfer on

pregnancy outcome. Of the four published RCTs, three reveal significantly higher pregnancy

rates in the acupuncture groups compared with the control groups. But the use of different study

protocols makes it difficult to draw definitive conclusions. It seems, however, that acupuncture

has a positive effect and no adverse effects on pregnancy outcome.

28

Influence of acupuncture stimulation on pregnancy rates for women

undergoing embryo transfer

Smith C et al, Fertil Steril 2006 Vol 85, pg 1352-1358

Fertility and Sterility

Abstract

OBJECTIVE: To evaluate the effects of acupuncture on clinical pregnancy rates for women

undergoing ET.

DESIGN: Single-blind, randomized controlled trial using a noninvasive sham acupuncture

control.

SETTING: Repromed, The Reproductive Medicine Unit of The University of Adelaide.

PATIENT(S): Women undergoing IVF.

INTERVENTION(S): Women were randomly allocated to acupuncture or noninvasive sham

acupuncture with the placebo needle. All women received three sessions, the first undertaken

on day 9 of stimulating injections, the second before ET, and the third immediately after ET.

MAIN OUTCOME MEASURE(S): The primary outcome was pregnancy. Secondary outcomes

were implantation, ongoing pregnancy rate at 18 weeks, adverse events, and health status.

RESULT(S): Two hundred twenty-eight subjects were randomized. The pregnancy rate was

31% in the acupuncture group and 23% in the control group. For those subjects receiving

acupuncture, the odds of achieving a pregnancy were 1.5 higher than for the control group, but

the difference did not reach statistical significance. The ongoing pregnancy rate at 18 weeks

was higher in the treatment group (28% vs. 18%), but the difference was not statistically

significant.

CONCLUSION(S): There was no significant difference in the pregnancy rate between groups;

however, a smaller treatment effect cannot be excluded. Our results suggest that acupuncture

was safe for women undergoing ET.

Acupuncture on the day of embryo transfer significantly improves the

reproductive outcome in infertile women: a prospective, randomized

trial

Westergaard L et al, Fertil Steril 2006 Vol 85, pg 1341-1346

Fertility and Sterility

Abstract

29

OBJECTIVE: To evaluate the effect of acupuncture on reproductive outcome in patients treated

with IVF/intracytoplasmic sperm injection (ICSI). One group of patients received acupuncture on

the day of ET, another group on ET day and again 2 days later (i.e., closer to implantation day),

and both groups were compared with a control group that did not receive acupuncture.

DESIGN: Prospective, randomized trial.

SETTING: Private fertility center.

PATIENT(S): During the study period all patients receiving IVF or ICSI treatment were offered

participation in the study. On the day of oocyte retrieval, patients were randomly allocated (with

sealed envelopes) to receive acupuncture on the day of ET (ACU 1 group, n = 95), on that day

and again 2 days later (ACU 2 group, n = 91), or no acupuncture (control group, n = 87).

INTERVENTION(S): Acupuncture was performed immediately before and after ET (ACU 1 and

2 groups), with each session lasting 25 minutes; and one 25-minute session was performed 2

days later in the ACU 2 group.

MAIN OUTCOME MEASURE(S): Clinical pregnancy and ongoing pregnancy rates in the three

groups.

RESULT(S): Clinical and ongoing pregnancy rates were significantly higher in the ACU 1 group

as compared with controls (37 of 95 [39%] vs. 21 of 87 [26%] and 34 of 95 [36%] vs. 19 of 87

[22%]). The clinical and ongoing pregnancy rates in the ACU 2 group (36% and 26%) were

higher than in controls, but the difference did not reach statistical difference.

CONCLUSION(S): Acupuncture on the day of ET significantly improves the reproductive

outcome of IVF/ICSI, compared with no acupuncture. Repeating acupuncture on ET day +2

provided no additional beneficial effect.

Impact of acupuncture before and after embryo transfer on the

outcome of in vitro fertilization cycles: A prospective single blind

randomized study

Benson M. R. et al, Fertil Steril 2006 Vol 86, Issue 3, pg S135

Fertility and Sterility

Abstract

OBJECTIVE: The study was conducted to examine several adjunct treatment regimens

administered before and after embryo transfer and determine if one treatment was more

efficacious than any of the alternative regimens on in vitro fertilization (IVF) outcome. We

compared two different acupuncture stimulation modes, needle and laser acupuncture, with

sham laser acupuncture, relaxation, or no intervention treatment on implantation and pregnancy

rates in women undergoing IVF.

30

DESIGN: Prospective single blind randomized trial. MATERIALS AND METHODS: Patients

(n258) who had been scheduled for embryo transfer (ET), signed informed consent and were

randomly assigned to one of 5 study treatment regimens; needle acupuncture (AC; 53), laser

acupuncture (LZ AC; n53), sham laser acupuncture (placebo)(LZ sham; n52), relaxation (RX;

n50), or no intervention treatment (NT; n50). All treatments were administered 25 minutes

before ET and immediately after ET. The patient and acupuncturist were unaware of whether

the laser system was active which allowed for a double-blind control group for the laser

acupuncture treatment. Comparisons of various parameters between groups were conducted by

2 tests and one-way ANO- As.. Multinomial logistic regression analysis was used to control for

the potentially confounding effects of day of embryo transfer (day 3 vs.5) and number of

embryos transferred which are known to relate to IVF outcome, to further analyze the impact of

adjunct treatment regimens on implantation and pregnancy rates. Probability of P 0.05 was

considered to be statistically significant.

RESULTS: No differences in terms of cycle type, day of embryo transfer, or physician

performing transfer were found between treatment groups. Neither day of transfer (p0.079) or

egg number (P 0.082) were significant independent predictors of implantation or conception

when interactions between parameters were considered in all 5 groups. All acupuncture

treatments were well tolerated.

CONCLUSION: Conception and implantation rates were highest with traditional needle

acupuncture. IVF treatment outcomes did not differ between patients treated with laser or sham

laser acupuncture. This study did not have the statistical power to detect treatment differences

in pregnancy rates between needle acupuncture and no treatment (i.e., at least 200 subjects are

needed to detect differences in CP rates of 54.7 and 44% with 80% power) which may be due to

sample size, transfer of embryos of varying quality and variations in stimulation protocols.

However, while not statistically significant, needle acupuncture produced a clinically significant

effect (greater than 10% increase in clinical pregnancy rate) compared with relaxation or no

treatment which warrants further investigation.

The impact of acupuncture on IVF outcome

Domar A et al, Fertil Steril 2006 Vol 86 Suppl 2, pg S378-379

Fertility and Sterility

Abstract

OBJECTIVE: The purpose of this study was to replicate previous research on the efficacy of

acupuncture in increasing pregnancy rates in IVF and determine if the increase in conceptions

was due to a placebo effect.

DESIGN: This was a randomized, controlled, prospective, single blind design.

MATERIALS AND METHODS: 83 women scheduled to undergo embryo transfer from a fresh

cycle using their own eggs were recruited to participate in the study. Subjects completed a

battery of demographic and psychological questionnaires prior to randomization and were then

31

assigned to either the acupuncture or control condition. Acupuncture subjects received the

protocol first described by Paulus et al, 2002, which included 22 needles, for 25 minutes prior to

and again 25 minutes following embryo transfer. Control subjects lay quietly for the same

amounts of time.

All subjects completed another battery of psychological questionnaires following their second

acupuncture/control session which focused on their sense of optimism about the outcome of the

cycle. All IVF staff remained blind to subject assignment.

RESULTS: The mean age of the acupuncture patients was 36.5 and for the control subjects

was 35.3 (p0.05). The mean number of embryos transferred for the acupuncture patients was

2.58 and for the controls 2.56 (p0.05). The pregnancy rate (defined as a positive HCG level 11

days following ET) was 53.84% in the acupuncture group and 52.94% in the control group

(p0.05). There were also no significant differences between the two groups in optimism level

post-embryo transfer, although there was a trend for the acupuncture group to express more

optimism.

CONCLUSION: The use of acupuncture with IVF patients was not associated with an increase

in pregnancy rates or optimism. This study did not replicate previous research. Possible

explanations include the fact that this study differed in three ways from the Paulus et al study:

all ET patients were eligible, not just patients with good embryo quality,

all staff were blind to subject assignment, not just the attending physician,

patients completed several psychological questionnaires which might have impacted them in

some way.

Since there were no differences in pregnancy rates, it was not possible to determine if

acupuncture is associated with a placebo effect.

Improvement of IVF Outcomes by Acupuncture: Are egg and embryo

qualities involved?

Paul C. Magarelli, M.D., Ph.D., a Diane Cridennda, L.Ac. b, Mel Cohen, MBA a

a Reproductive Medicine & Fertility Center, Colorado Springs, CO b East Winds Acupuncture,

Colorado Springs, CO

FERTILITY AND STERILITY®, May 2005, VOL 83, SUP 2, Proceeding from the 2005 Pacific

Coast Reproductive Society annual meeting in Palm Springs

Objective: In this study, we examine the impact of Acupuncture on the embryology

characteristics of IVF patients, i.e., are there changes in the numbers of eggs generated,

embryos fertilized, embryos transferred or remaining embryos for freezing in those patients

receiving acupuncture therapy.

Design: Retrospective clinical study

32

Setting: Private infertility practice and Traditional Chinese Medicine practice

Patients: Two hundred eight IVF cycles were reviewed, 95 received acupuncture (Ac) and 113

were controls (C).

Interventions: Patients randomly chose Ac to complement their IVF treatments. Two published

Ac protocols were used. Standard IVF protocols were used and done in one clinic by one

physician. The MD was not aware of who received Ac in addition to their IVF. After three years

the data were collected and analyzed.

Main Outcome Measures: Number of eggs retrieved, number of eggs fertilized normally, number

of embryos implanted, number of embryos frozen, number of embryos transferred, day of

transfer, number of prior IVF cycles, Day 3 FSH, Pulsitility Indices, weight, infertility diagnoses,

IVF treatment protocols, pregnancy rates, SAB rates, ectopic rates, and multiple pregnancy

rates.

Results: Number of prior IVF cycles, Day 3 FSH, Pulsitility Indices, Weight, Infertility diagnoses,

IVF treatment protocols were statistically similar. Pregnancy rates for the Ac group were

statistically significantly higher than the C group (P ≤ 0.05), SAB rates were lower and multiple

pregnancy rates were lower (P < 0.06, not statistically significant). Ectopic pregnancy rates were

statistically lower in the Ac group (P ≤ 0.05). There were no statistically significant differences

between the C and Ac treated groups for the following embryology parameters: number of eggs

retrieved, number of eggs fertilized normally, number of embryos implanted, number of embryos

frozen, number of embryos transferred, and day of transfer.

Conclusions: There were no discernable statistical differences between embryology

characteristics in patients treated with or without Acupuncture. These data suggests that the

mechanism of action of Acupuncture on IVF outcomes may be related to affects in the host (the

egg provider and the embryo recipient) rather than in direct changes to the eggs retrieved and

the embryos created.

Key Words: IVF, acupuncture, adjuvant therapies, electro stimulation acupuncture, embryology,

eggs

Acupuncture and In Vitro Fertilization: Does the Number of Treatments Impact Reproductive

Outcomes?

D.K. Cridennda L.Ac.(1), P.C. Magarelli MD, Ph.D. (2) , and M. Cohen, MBA (2).

(1), East Winds Acupuncture Colorado Springs, CO; (2) Reproductive Medicine & Fertility

Center, Colorado Springs, CO

Objective: The purpose of this study was to determine the optimal number of acupuncture

treatments that provide the patient with the best IVF outcomes, i.e., pregnancy.

Materials and Methods: Retrospective clinical study in private practice Acupuncture and IVF

center. Data were compiled in a group of infertile patients (n = 216) who received acupuncture

during their IVF treatment cycle between 2001 and 2005. Data were analyzed to determine the

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optimal number of Electrical Stimulation (e-Stim) acupuncture treatments (Stener-Victorin

protocol) that would result in a clinical pregnancy. Two hundred sixteen patients over a 4 year

period were included in this study. Based on our previous studies, we determined a significant

improvement in IVF outcomes when patients were treated with Acupuncture (Ac). We utilized

two protocols: Stener-Victorin et al 1996 (reported on uterine blood flow) and Paulus et al. 2002

protocol (reported on acupuncture given just before and just after embryo transfer). Patients

received a combination of both protocols. This population was stratified into pregnant and non-

pregnant groups and then evaluated by Student T=test and Chi-Square analysis for age, FSH

levels, weight, BMI and E-2 levels. The pregnant and non-pregnant groups were further

subdivided into those that received or did not receive acupuncture and were analyzed by Chi-

square analysis. Since all patients received acupuncture consisting of e-Stim, their distribution

was analyzed utilizing Kaplan- Meier survival analysis for pregnancy and no pregnancy to

determine the number of e-stimulation that would provide the greatest chance for pregnancy.

Results: Patients age, day 3 FSH levels, weight, BMI (body mass index) and E2 (estrogen level

at embryo transfer) were not statistically significantly different between the Non Acupuncture

(No Ac) and the Acupuncture (Ac) groups. There was a statistically significant improvement (p <

0.01) in pregnancy rates in the group that received Ac (49 patients of 106 (37.4%) in the No Ac

became pregnant vs. 77 patients of 111 (61.1%) of the Ac group became pregnant). This is over

23% increase in pregnancy rates in the Ac group. When the data were compared between e-

Stim treatments in the Ac only group, an average of 6.5 treatments were found in the non-

pregnant Ac group and 5.9 treatments in pregnant Ac group (not statistically significantly

different). When the data were plotted comparing pregnant vs. non pregnant Ac patients, there

was a trend towards numerically more e-Stim treatments in those who achieved a pregnancy. In

order to confirm or refute differences in these two groups, Kaplan Meier's survival analyses

were done. Based on these analyses, the average accumulated affect in the non-pregnant Ac

group was 5.1 e-Stim treatments and 8.4 e-Stim treatments in the pregnant Ac group. This was

statistically significantly different at the p < 0.05.

Conclusion: In traditional Chinese medicine the basic theory is that only when the body is

balanced will it function at its optimal level. Acupuncture helps restore balance which results in a

higher chance of achieving pregnancy. In our study, we found that patients who received more

than 8 e-Stim treatments appeared to have the maximum benefit for IVF outcomes: pregnancy

(p < 0.05). In our study, we also reviewed the independent effects of the Paulus protocol,

however due to small numbers; we could not perform the analyses. In the IVF center included in

this study, patients receive Valium (diazepam) to reduce smooth muscle contractility. This

treatment may provide all that is needed to reduce uterine contractility and therefore the

additional impact of Ac at the pre and post transfer (Paulus protocol) may well be masked by the

medication. More study of these and other treatments must be done. We are currently

investigating the role of Ac in stress hormone circulating levels.

Source : No outside source of funding.

Effect of acupuncture on the pregnancy rate in embryo transfer and

mechanisms: A randomized and controlled study

34

Zhang M et al, Chin Acup and Moxabustion 2003, Jan 23 (1): 3 - 5

A randomized, controlled, double-blind, cross-over study evaluating acupuncture as an adjunct

to IVF

Chinese Acupuncture and Moxabustion

210 IVF patients were randomly placed in groups that received real acupuncture or placebo or

no treatment on the day of embryo transfer. The pregnancy rate was significantly higher in the

group who received real acupuncture. Additionally this trial showed that the women who

received real acupuncture had fewer uterine contractions after the transfer.

Abstract

Objective To observe the effect of acupuncture on the pregnancy rate in assisted reproduction

therapy such as in-vitro-fertilization (IVF) and intracytoplasmic spermatozoen injection (ICSI),

and mechanisms.

Methods 210 cases undergoing IVF or ICSI were divided randomly into three groups:

acupuncture treatment group, placebo group and control group. The acupuncture treatment

group and the placebo group were treated respectively with body acupuncture and placebo

acupuncture before and after embryo transfer, and in the control group embryos were

transferred without any supportive therapy. Contraction frequency of the uterine junctional zone

and the pregnancy rate were observed. Results The contraction frequency before embryo

transfer was not significantly different among the three groups, but after embryo transfer in the

acupuncture treatment group was lower than that in the placebo group and the control group,

respectively. The pregnancy rate was 44.3% (31/70) in the acupuncture treatment group, and

27.1% (19/70) in the placebo group and 24.3% (17/70) in the control group. The pregnancy rate

in the acupuncture treatment group was significantly higher than that in the placebo

acupuncture group and the control group (P0.05).

Conclusion Acupuncture is a powerful tool for improving pregnancy rate after assisted

reproduction therapy.

Influence of acupuncture on the pregnancy rate in patients who

undergo assisted reproduction therapy

Paulus W et al, Fertil Steril 2002 Vol 77, pg 721-724

Fertility and Sterility

Abstract

OBJECTIVE: To evaluate the effect of acupuncture on the pregnancy rate in assisted

reproduction therapy (ART) by comparing a group of patients receiving acupuncture treatment

shortly before and after embryo transfer with a control group receiving no acupuncture.

DESIGN: Prospective randomized study.

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SETTING: Fertility center.

PATIENT(S): After giving informed consent, 160 patients who were undergoing ART and who

had good quality embryos were divided into the following two groups through random selection:

embryo transfer with acupuncture (n = 80) and embryo transfer without acupuncture (n = 80).

INTERVENTION(S): Acupuncture was performed in 80 patients 25 minutes before and after

embryo transfer. In the control group, embryos were transferred without any supportive therapy.

MAIN OUTCOME MEASURE(S): Clinical pregnancy was defined as the presence of a fetal sac

during an ultrasound examination 6 weeks after embryo transfer.

RESULT(S): Clinical pregnancies were documented in 34 of 80 patients (42.5%) in the

acupuncture group, whereas pregnancy rate was only 26.3% (21 out of 80 patients) in the

control group.

CONCLUSION(S): Acupuncture seems to be a useful tool for improving pregnancy rate after

ART.

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Acupuncture and IVF Miscellaneous

Acupuncture on the day of embryo transfer: a randomized controlled

trial of 635 patients.

Andersen D, Løssl K, Andersen AN, Fürbringer J, Bach H, Simonsen J, Larsen EC

The Fertility Clinics, Copenhagen University Hospital, Rigshospitalet, 2100 Copenhagen,

Denmark. Reprod Biomed Online. 2010 Apr 7. [Epub ahead of print]

Abstract

This prospective, randomized, controlled and double-blinded trial studied whether acupuncture

in relation to embryo transfer could increase the ongoing pregnancy rates and live birth rates in

women undergoing assisted reproductive therapy. A total of 635 patients undergoing IVF or

intracytoplasmic sperm injection (ICSI) were included. In 314 patients, embryo transfer was

accompanied by acupuncture according to the principles of traditional Chinese medicine. In the

control group, 321 patients received placebo acupuncture using a validated placebo needle. In

the acupuncture group and the placebo group, the ongoing pregnancy rates were 27% (95% CI

22-32) and 32% (95% CI 27-37), respectively. Live birth rates were 25% (95% CI 20-30) in the

acupuncture group and 30% (95% CI 25-30) in the placebo group. The differences were not

statistically significant. These results suggest that acupuncture administered in relation to

embryo transfer has no effect on the outcome of IVF and ICSI

Acupuncture and herbal medicine in in vitro fertilization: a review of

the evidence for clinical practice

Cheong Y et al. . Hum Fertil 2010 Jan 7. [Epub ahead of print

A systematic review and meta-analysis that looked at the effectiveness of acupuncture and

Chinese herbal medicine in the treatment of male and female subfertility by assisted

reproductive technologies (ART). It included 14 randomized controlled trials involving a total of

2,670 participants of acupuncture and/or Chinese herbal medicine in ART The outcome

measures were: live birth rate, ongoing pregnancy rate, clinical pregnancy rate, the incidence of

ovarian hyperstimulation syndrome and multiple pregnancy, miscarriage rate and adverse

effects arising from treatment. Adjunctive acupuncture improved live birth and pregnancy rates

but the superiority over control groups was not statistically significant. Hence the reviewers

concluded that